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Damani A, Ghoshal A, Thota R, Jain PN. Initial Experiences With Integration of Palliative Medicine and Specialist Pain Services in a Tertiary Cancer Care Center in India. J Pain Palliat Care Pharmacother 2024; 38:95-102. [PMID: 38557234 DOI: 10.1080/15360288.2024.2320379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/10/2024] [Indexed: 04/04/2024]
Abstract
Pain management constitutes a pivotal aspect of palliative care. Certain instances of distressing pain are significantly relieved through interventional pain methodologies, demanding the expertise of pain specialists. Our perspective revolves around the integration of these 2 facets, envisaging a symbiotic relationship that could enhance patient outcomes. A prospective assessment was carried out within a collaborative clinic, uniting the realms of pain management and palliative medicine. Anonymized patient information was scrutinized to grasp the advantages of this amalgamation and identify strategies to address any inherent deficiencies. Furthermore, an illustrative case study was delineated, spotlighting the collaborative dynamics at a systemic level. During the period spanning from November 2020 to June 2021, a total of 43 patients received consultations at this collaborative clinic. Each patient was exposed to a comprehensive pain management regimen, with the most frequently conducted procedure being an intercostal nerve block, which was administered in 9.30% of cases. For the provision of effective pain relief within the palliative care context, the confluence of joint consultations from cancer pain specialists emerges as a requisite measure. This approach carries the promise of optimizing pain control and augmenting the quality of palliative care.
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Affiliation(s)
- Anuja Damani
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Raghu Thota
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Parmanand N Jain
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Ravindranath R, Sarma PS, Sivasankaran S, Thankappan KR, Jeemon P. Voices of care: unveiling patient journeys in primary care for hypertension and diabetes management in Kerala, India. Front Public Health 2024; 12:1375227. [PMID: 38846619 PMCID: PMC11155455 DOI: 10.3389/fpubh.2024.1375227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
Background Diabetes and hypertension are leading public health problems, particularly affecting low- and middle-income countries, with considerable variations in the care continuum between different age, socio-economic, and rural and urban groups. In this qualitative study, examining the factors affecting access to healthcare in Kerala, we aim to explore the healthcare-seeking pathways of people living with diabetes and hypertension. Methods We conducted 20 semi-structured interviews and one focus group discussion (FGD) on a purposive sample of people living with diabetes and hypertension. Participants were recruited at four primary care facilities in Malappuram district of Kerala. Interviews were transcribed and analyzed deductively and inductively using thematic analysis underpinned by Levesque et al.'s framework. Results The patient journey in managing diabetes and hypertension is complex, involving multiple entry and exit points within the healthcare system. Patients did not perceive Primary Health Centres (PHCs) as their initial points of access to healthcare, despite recognizing their value for specific services. Numerous social, cultural, economic, and health system determinants underpinned access to healthcare. These included limited patient knowledge of their condition, self-medication practices, lack of trust/support, high out-of-pocket expenditure, unavailability of medicines, physical distance to health facilities, and attitude of healthcare providers. Conclusion The study underscores the need to improve access to timely diagnosis, treatment, and ongoing care for diabetes and hypertension at the lower level of the healthcare system. Currently, primary healthcare services do not align with the "felt needs" of the community. Practical recommendations to address the social, cultural, economic, and health system determinants include enabling and empowering people with diabetes and hypertension and their families to engage in self-management, improving existing health information systems, ensuring the availability of diagnostics and first-line drug therapy for diabetes and hypertension, and encouraging the use of single-pill combination (SPC) medications to reduce pill burden. Ensuring equitable access to drugs may improve hypertension and diabetes control in most disadvantaged groups. Furthermore, a more comprehensive approach to healthcare policy that recognizes the interconnectedness of non-communicable diseases (NCDs) and their social determinants is essential.
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Affiliation(s)
- Ranjana Ravindranath
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P. Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | | | | | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Kalita A, Carton-Rossen N, Joseph L, Chhetri D, Patel V. The Barriers to Universal Health Coverage in India and the Strategies to Address Them: A Key Informant Study. Ann Glob Health 2023; 89:69. [PMID: 37841807 PMCID: PMC10573738 DOI: 10.5334/aogh.4120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background India has adopted several policies toward improving access to healthcare and has been an enthusiastic signatory to several global health policies to achieve Universal Health Coverage (UHC). However, despite these policy commitments, there has been limited success in realizing these goals. The COVID-19 pandemic has highlighted the urgent need for health system re-design and amplified the calls for such reforms. Objectives We seek to understand the views of a diverse group of policy actors in India to address the following research questions: what are the (i) conceptualizations of UHC, (ii) main barriers to realizing UHC, and (iii) policy strategies to address these barriers. Data and Methods We collected data through in-depth interviews with 38 policy actors from diverse backgrounds and analyzed using the Framework Method to develop themes both inductively and deductively using the Control Knob Framework of health systems. Findings There was congruence in the conceptualization of UHC by policy actors. Quality of care, equity, financial risk protection, and a comprehensive set of services were the most commonly cited features. The lack of a comprehensive systems approach to health policies, inadequate and inefficient health financing mechanisms, and fragmentation between public and private sectors were identified as the main barriers to UHC. Contrasting views about specific strategies, health financing, provider payments, organization of the delivery system, and regulation emerged as the key policy interventions to address these barriers. Discussion and Conclusion This is the first systematic examination of a diverse set of policy actors' problem analyses and suggestions to advance UHC goals in India. The study underscores the need to recognize the complex and interlinked nature of health system reforms and initiate a departure from path-dependent vertical interventions to bring about transformative change.
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Affiliation(s)
| | | | - Linju Joseph
- Achutha Menon Centre for Health Science Studies, India
- University of Birmingham, UK
| | | | - Vikram Patel
- Harvard T.H. Chan School of Public Health, USA
- Harvard Medical School, USA
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Patel V. Re-imagining the care delivery system for chronic conditions. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 13:100232. [PMID: 37383561 PMCID: PMC10306039 DOI: 10.1016/j.lansea.2023.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/30/2023]
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Chaturvedi S, Porter J, Gopalakrishna Pillai GK, Abraham L, Shankar D, Patwardhan B. India and its pluralistic health system - a new philosophy for Universal Health Coverage. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 10:100136. [PMID: 36938332 PMCID: PMC10015266 DOI: 10.1016/j.lansea.2022.100136] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023]
Abstract
In this article we attempt to put forth insights into using traditional medicine (TM) systems to achieve Universal Health Coverage (UHC). We discuss the need for reimagining India's health system and the importance of an inclusive approach for UHC. We comprehend the challenges with appropriate use of TM systems and the lessons from international experience of integrating TM systems. We highlight the pathways for better utilization of TM systems for UHC in India.
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Affiliation(s)
| | - John Porter
- Clinical Research and Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Leena Abraham
- Centre for Studies in Sociology of Education, Tata Institute of Social Sciences, Mumbai, India
| | - Darshan Shankar
- Transdisciplinary University of Health Sciences and Technology, Bengaluru, India
| | - Bhushan Patwardhan
- Centre for Complementary and Integrative Health, Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India
- Corresponding author. National Research Professor-AYUSH, Savitribai Phule Pune University, Pune, India 411007.
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Marklund M, Cherukupalli R, Pathak P, Neupane D, Krishna A, Wu JH, Neal B, Kaur P, Moran AE, Appel LJ, Matsushita K. Hypertension treatment capacity in India by increased workforce, greater task-sharing, and extended prescription period: a modelling study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 10:100124. [PMID: 37383361 PMCID: PMC10306017 DOI: 10.1016/j.lansea.2022.100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 06/30/2023]
Abstract
Background The worldwide control rate for hypertension is dismal. An inadequate number of physicians to treat patients with hypertension is one key obstacle. Innovative health system approaches such as delegation of basic tasks to non-physician health workers (task-sharing) might alleviate this problem. Massive scale up of population-wide hypertension management is especially important for low- and middle-income countries such as India. Methods Using constrained optimization models, we estimated the hypertension treatment capacity and salary costs of staff involved in hypertension care within the public health system of India and simulated the potential effects of (1) an increased workforce, (2) greater task-sharing among health workers, and (3) extended average prescription periods that reduce treatment visit frequency (e.g., quarterly instead of monthly). Findings Currently, only an estimated 8% (95% uncertainty interval 7%-10%) of ∼245 million adults with hypertension can be treated by physician-led services in the Indian public health system (assuming the current number of health workers, no greater task-sharing, and monthly visits for prescriptions). Without task-sharing and with continued monthly visits for prescriptions, the least costly workforce expansion to treat 70% of adults with hypertension would require ∼1.6 (1.0-2.5) million additional staff (all non-physicians), with ∼INR 200 billion (≈USD 2.7 billion) in additional annual salary costs. Implementing task-sharing among health workers (without increasing the overall time on hypertension care) or allowing a 3-month prescription period was estimated to allow the current workforce to treat ∼25% of patients. Joint implementation of task-sharing and a longer prescription period could treat ∼70% of patients with hypertension in India. Interpretation The combination of greater task-sharing and extended prescription periods could substantially increase the hypertension treatment capacity in India without any expansion of the current workforce in the public health system. By contrast, workforce expansion alone would require considerable, additional human and financial resources. Funding Resolve to Save Lives, an initiative of Vital Strategies, was funded by grants from Bloomberg Philanthropies; the Bill and Melinda Gates Foundation; and Gates Philanthropy Partners (funded with support from the Chan Zuckerberg Foundation).
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Affiliation(s)
- Matti Marklund
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Priya Pathak
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dinesh Neupane
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jason H.Y. Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Imperial College London, London, UK
| | - Prabhdeep Kaur
- National Institute of Epidemiology, The Indian Council of Medical Research, Chennai, Tamil Nadu, India
| | - Andrew E. Moran
- Resolve to Save Lives, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Lawrence J. Appel
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Chaudhuri A, Biswas N, Kumar S, Jyothi A, Gopinath R, Mor N, John P, Narayan T, Chatterjee M, Patel V. A theory of change roadmap for universal health coverage in India. Front Public Health 2022; 10:1040913. [PMID: 36530728 PMCID: PMC9751860 DOI: 10.3389/fpubh.2022.1040913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022] Open
Abstract
The Theory of Change (ToC) approach is one of the methodologies that the Lancet Citizens' Commission has chosen to build a roadmap to achieving Universal Healthcare (UHC) in India in the next 10 years. The work of the Citizens' Commission is organized around five workstreams: Finance, Human Resources for Health (HRH), Citizens' Engagement, Governance, and Technology. Five ToC workshops were conducted, one for each workstream. Individual workshop outputs were then brought together in two cross-workstream workshops where a sectoral Theory of Change for UHC was derived. Seventy-four participants, drawn from the Commission or invited for their expertise, and representing diverse stakeholders and sectors concerned with UHC, contributed to these workshops. A reimagined healthcare system achieves (1) enhanced transparency, accountability, and responsiveness; (2) improved quality of health services; (3) accessible, comprehensive, connected, and affordable care for all; (4) equitable, people-centered and safe health services; and (5) trust in the health system. For a mixed system like India's, achieving these high ideals will require all actors, public, private and civil society, to collaborate and bring about this transformation. During the consultation, paradigm shifts emerged, which were structural or systemic assumptions that were deemed necessary for the realization of all interventions. Critical points of consensus also emerged from the workshops, such as the need for citizen-centricity, greater efficiency in the use of public finances for health care, shifting to team-based managed care, empowerment of frontline health workers, the appropriate use of technology across all phases of patient care, and moving toward an articulation of positive health and wellbeing. Critical areas of contention that remained related to the role of the private sector, especially around financing and service delivery. Few issues for further consultation and research were noted, such as payment for performance across both public and private sectors, the use of accountability metrics across both public and private sectors, and the strategies for addressing structural barriers to realizing the proposed paradigm shifts. As the ToCs were developed in expert groups, citizens' consultations and consultations with administrative leaders were recommended to refine and ground the ToC, and therefore the roadmap to realize UHC, in people's lived reality.
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Affiliation(s)
| | | | - Shiv Kumar
- Catalyst Group, Swasti Health Catalyst, Bangalore, India
| | - Asha Jyothi
- Catalyst Group, Swasti Health Catalyst, Bangalore, India
| | | | - Nachiket Mor
- The Banyan Academy of Leadership in Mental Health, Thiruvidanthai, India
| | - Preethi John
- Global Business School for Health, University College London, London, United Kingdom
| | - Thelma Narayan
- Centre for Public Health and Equity (SOCHARA), Bangalore, India
| | | | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States,*Correspondence: Vikram Patel
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Patel V, Bhadada S, Mazumdar-Shaw K, Mukherji A, Khanna T, Kang G. A historic opportunity for universal health coverage in India. Lancet 2022; 400:475-477. [PMID: 35964597 DOI: 10.1016/s0140-6736(22)01395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Vikram Patel
- Harvard Medical School and Harvard T H Chan School of Public Health, Boston, MA 02115, USA; Sangath, Goa, India.
| | - Shubhangi Bhadada
- The Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA, USA
| | | | - Arnab Mukherji
- Center for Public Policy, IIM Bangalore, Bengaluru, India
| | - Tarun Khanna
- Harvard Business School and The Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA, USA
| | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
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Hunter BM, Murray SF, Marathe S, Chakravarthi I. Decentred regulation: The case of private healthcare in India. WORLD DEVELOPMENT 2022; 155:105889. [PMID: 36846632 PMCID: PMC9941715 DOI: 10.1016/j.worlddev.2022.105889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 06/16/2023]
Abstract
In order to progress towards more equitable social welfare systems we need an improved understanding of regulation in social sectors such as health and education. However, research to date has tended to focus on roles for governments and professions, overlooking the broader range of regulatory systems that emerge in contexts of market-based provisioning and partial state regulation. In this article we examine the regulation of private healthcare in India using an analytical approach informed by 'decentred' and 'regulatory capitalism' perspectives. We apply these ideas to qualitative data on private healthcare and its regulation in Maharashtra (review of press media, semi-structured interviews with 43 respondents, and three witness seminars), in order to describe the range of state and non-state actors involved in setting rules and norms in this context, whose interests are represented by these activities, and what problems arise. We show an eclectic set of regulatory systems in operation. Government and statutory councils do perform limited and sporadic regulatory roles, typically organised around legislation, licensing and inspections, and often prompted by the judicial arm of the state. But a range of industry-level actors, private organisations and public insurers are involved too, promoting their own interests in the sector via the offices of regulatory capitalism: accreditation companies, insurers, platform operators and consumer courts. Rules and norms are extensive but diffuse. These are produced not just through laws, licensing and professional codes of conduct, but also through industry influence over standards, practices and market organisation, and through individualised attempts to negotiate exceptions and redressal. Our findings demonstrate regulation in a marketised social sector to be partial, disjointed and decentred to multiple loci, actively representing differing interests. Greater understanding of the different actors and processes at play in such contexts can inform future progress towards universal systems for social welfare.
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Affiliation(s)
- Benjamin M. Hunter
- Department of International Development, University of Sussex, UK
- Department of International Development, King’s College London, UK
| | - Susan F. Murray
- Department of International Development, King’s College London, UK
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Parikh N, Chaudhuri A, Syam SB, Singh P, Pal P, Pillala P. Diseases and Disparities: The Impact of COVID-19 Disruptions on Sexual and Reproductive Health Services Among the HIV Community in India. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:315-329. [PMID: 35048205 PMCID: PMC8769775 DOI: 10.1007/s10508-021-02211-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 05/07/2023]
Abstract
People with HIV navigate numerous challenges to access healthcare in India. The lockdown in response to the COVID-19 pandemic presents further challenges in accessing sexual and reproductive health (SRH) services. This research explored the impact of the pandemic on SRH services, and the depth of disruptions faced by people living with HIV (PLHIV) in accessing treatment. Using purposive sampling with maximum variation technique, we recruited and conducted 150 telephonic in-depth interviews with PLHIV and HIV care providers (HCPs) from five states in India (Karnataka, Tamil Nadu, Maharashtra, Andhra Pradesh, and Telangana). The interviews were recorded, transcribed, coded, and analyzed using interpretative phenomenological analysis. Five main themes were identified: the effect of COVID-19 on (1) access to care, (2) quality of care, (3) social determinants of health, (4) system and community resilience, and (5) support required to address population-specific vulnerabilities. Despite the availability of free government treatment services during the pandemic, profound disruptions in the SRH services, particularly antiretroviral therapy and HIV care, were reported by PLHIV and HCPs. This qualitative study revealed how existing inequities in HIV treatment and care are exacerbated by the pandemic. These findings highlight that the pandemic response should be community-centered to prevent extreme disruptions in healthcare which will have a disastrous effect on the lives of PLHIV.
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Affiliation(s)
- Neha Parikh
- Swasti Health Catalyst, 25, 3rd Floor, Raghavendra Nilaya, 1st Main Road, AECS Layout, Ashwathnagar, near Paratha Plaza, Bengaluru, Karnataka, 560094, India.
| | - Angela Chaudhuri
- Swasti Health Catalyst, 25, 3rd Floor, Raghavendra Nilaya, 1st Main Road, AECS Layout, Ashwathnagar, near Paratha Plaza, Bengaluru, Karnataka, 560094, India
| | - Syama B Syam
- Swasti Health Catalyst, 25, 3rd Floor, Raghavendra Nilaya, 1st Main Road, AECS Layout, Ashwathnagar, near Paratha Plaza, Bengaluru, Karnataka, 560094, India
| | - Pratishtha Singh
- Swasti Health Catalyst, 25, 3rd Floor, Raghavendra Nilaya, 1st Main Road, AECS Layout, Ashwathnagar, near Paratha Plaza, Bengaluru, Karnataka, 560094, India
| | - Prachi Pal
- Institute of Development Studies, University of Sussex, Brighton, UK
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Affiliation(s)
- Anita Kar
- Birth Defects and Childhood Disability Research Centre, Pune 411020, India.
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Aiyar Y, Chandru V, Chatterjee M, Desai S, Fernandez A, Gupta A, Kang G, Khanna T, Mazumdar-Shaw K, Mor N, Mukherji A, Muttreja P, Narayan T, Patwardhan B, Rao KS, Sharma S, Shetty D, Subramanian SV, Varkey LEC, Venkateswaran S, Patel V. India's resurgence of COVID-19: urgent actions needed. Lancet 2021; 397:2232-2234. [PMID: 34048696 PMCID: PMC8148651 DOI: 10.1016/s0140-6736(21)01202-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | | | - Armida Fernandez
- Lokmanya Tilak Municipal Medical Hospital and College, Mumbai, India and SNEHA, Mumbai, India
| | - Atul Gupta
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Tarun Khanna
- Harvard Business School and The Lakshmi Mittal and Family South Asia Institute, Harvard University, Cambridge, MA, USA
| | | | - Nachiket Mor
- The Banyan Academy of Leadership in Mental Health, Bengaluru, India
| | - Arnab Mukherji
- Center for Public Policy, IIM Bangalore, Bengaluru, India
| | | | | | - Bhushan Patwardhan
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India; Interdisciplinary AYUSH Research and Development Task Force of Ministry of AYUSH, New Delhi, India
| | | | | | - Devi Shetty
- Narayana Hrudayalaya Limited, Bengaluru, India
| | - S V Subramanian
- Harvard Center for Population and Development Studies and Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | | | | | - Vikram Patel
- Harvard Medical School and Harvard T H Chan School of Public Health, Boston, MA 02144, USA; Sangath, Goa, India.
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